rheumatology - the future...complex regional pain syndrome fibromyalgia foot pain gout joint...
TRANSCRIPT
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Rheumatology - The Future
Dr Jeremy McNally MBBS, BSc (Hons), FRCP
Consultant Rheumatologist
The Royal Berkshire NHS Foundation Trust
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Navigating the Arthritis Maze
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Navigating the Arthritis Maze
Rheumatology
− Multisystem disease ‘last of the general physicians’
− Multidisciplinary specialty (Nurse, physiotherapist, OT)
− Rapidly expanding field early diagnosis and treatment
− New targeted treatments in development
− Treatment allows patients to keep active and working
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Navigating the Arthritis Maze
Ankylosing spondylitisAntiphospholipid syndromeBack painBehçet's syndromeCalcium crystal diseases (pseudogout)Carpal tunnel syndromeComplex regional pain syndromeFibromyalgiaFoot painGoutJoint hypermobilityJuvenile idiopathic arthritis (JIA, arthritis in
childhood)Knee painNeck painLupus
Osteoarthritis
Osteoarthritis of the knee
Osteomalacia (soft bones)
Osteoporosis
Paget's disease of bone
Patellofemoral pain syndrome
Polymyalgia rheumatica (PMR)
Polymyositis and dermatomyositis
Psoriatic arthritis
Raynaud's phenomenon
Reactive arthritis
Rheumatoid arthritis
Scleroderma
Shoulder pain
Sjögren's syndrome
Tennis elbow
Vasculitis
A to Z of Arthritis
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Navigating the Arthritis Maze
What causes arthritis?
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Navigating the Arthritis Maze
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Navigating the Arthritis Maze
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Navigating the Arthritis Maze
Why me?
Genetics
Hormones
Environment
• Smoking
• Diet
Infection
• Viruses
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Navigating the Arthritis Maze
Rheumatoid arthritis
• Chronic inflammatory arthritis
• Affects 0.8-1.0% of the population in the UK
• 3 times commoner in women
• Can affect any age - usually starts 40-60 years
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Navigating the Arthritis Maze
‘Is it in the genes ?’
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Navigating the Arthritis Maze
Christian Barnard (1922 – 2001)
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Navigating the Arthritis Maze
Renoir (1841 – 1919)
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Navigating the Arthritis Maze
What about smoking?’
Increases the risk of developing severe RA
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Navigating the Arthritis Maze
‘Is it from what I eat?’
Mediterranean diet is protective
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Navigating the Arthritis Maze
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Navigating the Arthritis Maze
‘What about exercise?’
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Navigating the Arthritis Maze
− Pre-clinical Disease
− Acute inflammation
− Persists, spreads, damages
− Chronic Disease – DAMAGE and DISABILITY
Rheumatoid arthritis
Early Treatment
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Navigating the Arthritis Maze
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Navigating the Arthritis Maze
The S factor
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Navigating the Arthritis Maze
Early Arthritis
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Navigating the Arthritis Maze
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Navigating the Arthritis Maze
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Navigating the Arthritis Maze
Wallingford
Newbury (WBCH)
Townlands (Henley)
Woosehill (Woklingham)
Royal Berkshire Hospital(Reading)
Rheumatology Clinics`Care Closer to Home’
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Navigating the Arthritis Maze
Adapted from: van der Heijde D. Ann Rheum Dis. 2001;60:iii47-iii50.
Disease Activity
Disability
Structural Damage
Reduce
Decrease
Prevent
Goals of Management in RA
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Navigating the Arthritis Maze
The Evolving management of RA
“Rheumatism”(Guillaume de
Baillou)
“Rheumatoid Arthritis”(Sir Alfred
Garrod)
1591
1680s 1860sa
1859a
QuinineWillow Bark
1890sa
Manufactured Aspirin
1920s
Gold Injections
1940s
Steroids
1980s
Methotrexate(MTX)
1990s
Biologics
aAppelboom T. Rheumatology (Oxford). 2002;41(suppl 1):28-34.
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Navigating the Arthritis Maze
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Navigating the Arthritis Maze
Anti-TNF alpha treatment (biologic therapy)
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Navigating the Arthritis Maze
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Navigating the Arthritis Maze
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Navigating the Arthritis Maze
• Increase public awareness
• Early detection and aggressive treatment
• Remission is the mission (DMARDS/Biologics)
• ‘Personalised’ medicine (targeted therapies)
Summary
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Navigating the Arthritis Maze
Thank you.
Dr Jeremy McNallyConsultant Rheumatologist
Royal Berkshire NHSFTWest Berkshire Community Hospital
0118 322 6559Ms Beverley Wright
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Navigating the Arthritis Maze